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Membranous Nephropathy after Subcutaneous Mercury Injection.

Kelly Johnson-Arbor1, Sammy Taha2

  • 1Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, 3800 Reservoir Road, NW, Washington, DC, 20007, USA. kkja@me.com.

Journal of Medical Toxicology : Official Journal of the American College of Medical Toxicology
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PubMed
Summary
This summary is machine-generated.

Subcutaneous elemental mercury injection, typically safe, can cause serious kidney damage like membranous nephropathy. This case highlights the risk of systemic toxicity from intentional mercury self-injection.

Keywords:
COVID-19Membranous nephropathyMercury poisoningSelf-injurious behavior

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Area of Science:

  • Nephrology
  • Toxicology
  • Dermatology

Background:

  • Subcutaneous elemental mercury injection is generally considered low-risk for systemic toxicity.
  • A case report details a patient who developed persistent membranous nephropathy following intentional subcutaneous elemental mercury injection.

Purpose of the Study:

  • To report a rare case of systemic toxicity, specifically membranous nephropathy, resulting from subcutaneous elemental mercury injection.
  • To discuss the potential pathophysiology and management of mercury-induced nephropathy.

Main Methods:

  • A case study of a 21-year-old male with intentional subcutaneous elemental mercury injection into the forearm.
  • Clinical presentation included nodularity, subsequent development of proteinuria, and diagnosis of membranous nephropathy.
  • Interventions included attempted excision, rituximab treatment, surgical removal of mercury deposits, and chelation with succimer.

Main Results:

  • The patient developed persistent membranous nephropathy with elevated proteinuria and urine protein to creatinine ratio despite treatment.
  • Surgical excision of mercury deposits and chelation did not fully resolve the renal pathology.

Conclusions:

  • Subcutaneous elemental mercury injection can lead to significant systemic toxicity, including membranous nephropathy.
  • The pathophysiology may involve autoantibody and cytokine formation secondary to renal tubular injury.
  • Surgical excision is the primary treatment, with chelation considered for systemic toxicity or ongoing exposure.